Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: When is it indicated, what is the goal and how to do it?
Section snippets
INTRODUCTION
Pancreatic exocrine insufficiency is a major consequence of diseases leading to a loss of pancreatic parenchyma (e.g. chronic pancreatitis, cystic fibrosis), obstruction of the main pancreatic duct (e.g. pancreatic and ampullary tumors), decreased pancreatic stimulation (e.g. celiac disease), or acid-mediated inactivation of pancreatic enzymes (e.g. Zollinger-Ellison syndrome). In addition, gastrointestinal and pancreatic surgical resections (e.g. gastrectomy or duodenopancreatectomy) are
REVIEW
The aim of pancreatic enzyme substitution therapy is not only to avoid maldigestion-related symptoms, but mainly to ensure a normal nutritional status. Therapy of pancreatic exocrine insufficiency is based on the oral administration of exogenous pancreatic enzymes. Together with that, dietary modifications have classically played an important role that nowadays should probably be reconsidered.
CONCLUSIONS
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Pancreatic exocrine insufficiency is a frequent and life-threatening condition associated to different pancreatic and extrapancreatic diseases (acute pancreatitis, chronic pancreatitis, cystic fibrosis, pancreatic cancer, GI and pancreatic sugery).
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Therapy of pancreatic exocrine insuficiency should avoid symptoms and ensure a normal nutritional status.
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Oral pancreatic enzymes in form of enteric-coated mini-microspheres are the therapy of choice. A minimum dose of 40-50,000 Ph.U/lipase is usually
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